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Form H: Physician Approval
PHYSICIAN APPROVAL
I authorize (school district) to immunize (employee) against Hepatitis B.
Physician Signature
Date
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I authorize (school district) to immunize (employee) against Hepatitis B.
Physician Signature
Date
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A partnership of the Nebraska Department of Health & Human Services and UNL's Center on Children, Families, and the Law, UNL Extension at the University of Nebraska - Lincoln.
206 South 13th Street - Suite 1000 • Lincoln, Nebraska 68588-0227
800-746-8420 • 402-472-0844
A partnership of the Nebraska Department of Health & Human Services and UNL's Center on Children, Families, and the Law, UNL Extension at the University of Nebraska - Lincoln.
206 South 13th Street - Suite 1000 • Lincoln, Nebraska 68588-0227
800-746-8420 • 402-472-0844
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